Sesi ulangkaji TUGASAN KUMPULAN

Ismail a peadiatric patient complaint of sudden low in urine output of less than
250ml/day

urine are mix with blood

The nephrologist dianosed Ismail with acute kidney injury due to acute

glomerularnephritis (AGN),

a.i) What is the clinical manifestation acute glomerularnephritis (AGN). [3

marks]
I. Oedema (facial puffiness, lower limb swelling, anasarca)
II. Hypoalbuminemia – The loss of albumin results in hypoalbuminemia.
III. Proteinuria – Present of protein in the urine more than 3g/day.
IV. Hyperlipidemia – Altered lipid metabolism.
V. Hypertension due to fluid overload.
VI. Oliguria
VII. Anorexia
VIII. Anuria

Ismail was admitted to the paediatric nephrology ward for further management and
observation.

a.ii) You are asked to explain the management of acute glomerulonephritis

(AGN) for ismail in the ward (6marks)

I. Monitor vital sign. E.g Blood pressure, pulse rate, temperature

II. Asses general condition of patient, for example lethargy, oedema or SOB.
III. Adequate history taking and physical examination. To treat and manage the
underlying condition or disease.
IV. Investigations
- Blood investigation such as Renal Profile, ASOT (screening for
streptococcal antibody)
- Urine investigation e.g UFEME, 24H urine protein
- Renal biopsy – To obtain small kidney tissue and examine under
microscope
V. Initiate medication
- Control blood pressure is vital - even mild renal impairment or
proteinuria. Target BP less than 130/80mmHg. Tab Nifedipine (0.5 – 2
mg/ kg in children, every 4–6 h) is usually effective.
- Administration of loop diuretics (1-2 mg/kg, maximum up to 10 mg/kg,
IV or orally every 12 hr), used for control of hypertension & edema.
- Administer immunosuppressive drug such as mycophenolate mofetil,
cyclophosphamide, steroids and intravenous immunoglobulin.
 - Administer 10-day course of oral Penicillin V or erythromycin as
prescribed to eradicate any residual streptococcal infection.
VI. Health education
- Record an accurate daily total fluid intake and urine output.
- Restrict the fluid intake in the initial stage until the urine output
increases.
- Restrict sodium intake < 2.4g/24hrs and normal protein diet is
sufficient.
- Avoid salty foods, as they increase thirst, for examole processed foods.
- Advise on any food that is liquid at room temperature counts as a fluid.
This includes the following: Ice cubes , Ice cream, frozen yogurt
VII. Initiate dialysis - in severe renal impairment leading to volume excess or
electrolyte abnormalities that cannot otherwise be medically managed.
VIII. Documentation – Document all procedure for medicolegal.
IX. Follow up – To monitor renal profile and lipid profile

Lupus nephritis is a type of kidney disease caused by systemic lupus erythematosus

link (SLE or lupus). Lupus is an autoimmune disease link-a disorder in which the
body's immune system attacks the body's own cells and organs. Kidney disease
caused by lupus may get worse over time and lead to kidney failure.

As a nurse in the ward, you are asked to state the clinical manifestation of Lupus
Nephritis by the doctors

B.i) Please State the clinical manifestation of lupus nephritis. [3 marks]

1) Skin – malar rash and red patches
2) Hair - Alopecia
3) Mouth – Multiple ulcers
4) Muscle and joint – Arthritis aches, pain and swollen joint
5) Proteinuria
6) Hematuria
7) Nocturia

During ward round, the doctors have documented his management for Salmah in the
case note

b. ii ) Plase refer to the case note and explain the management of lupus nephritis for
Ismail. [6 marks]
I. Adequate history taking and physical examination. To treat and manage the
underlying condition or disease.
II. Investigations
- Blood investigation – Anti Nuclear Antibody (positive)
- Complement c3 c4 – To monitor inflammation
- Urine – UFEME, 24H urine protein
- Renal Biopsy - To obtain small kidney tissue and examine under
microscope.
 III. Initiate medication
- Tab Hydroxychloroquine 200mg to prevent activation and less
relapses.
- Immunosuppressive agent. E.g IV cyclophosphamide, MMF.
- NSAIDS e.g Ibuprofen
- Steroid e.g Prednisolone
- Initiate Intravenous Immunoglobulin (IVIG) If indicated.
IV. Initiate dialysis - Plasmapheresis to remove extra antibody from the blood.
V. Health Education – To wear mask in public and avoid crowded places.
VI. Follow up – To comply to follow up given.
VII. Consult transplantation if available.
VIII. Use suncreen to prevent UV rays / Avoid photosensitivity.
IX. Advice patient to join support SLE group.
X. Educate patient regarding complication of SLE.
XI. Involve family member during counselling
XII. Advice patient to seek medical help if any complication occur.

Glomerular disease reduces the kidneys' ability to maintain a balance of certain

substances in bloodstream and the third most common cause of chronic kidney
disease.